Chapter 4. Medication Therapy Management

After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:

1. Explain how pharmacists are in a unique position to provide medication therapy management (MTM) services.

2. Recognize the differences between MTM and pharmaceutical care.

3. Explain how MTM services are implemented with the five core elements.

4. Discuss how innovative patient care programs have assisted in the development of MTM.

5. Recognize how implementation of MTM services is evolving into the overall health-care structure.

Nearly half of all Americans have at least one chronic illness1 resulting in millions of patients relying on prescription medications to help maintain their health. This prevalence of medication use creates a significant opportunity for both medical and monetary consequences if these agents are not managed safely and effectively. Unfortunately, evidence suggests that our health system is not performing well in this regard. It is estimated that 1.5 million preventable adverse drug events (ADEs) occur in our health system each year2 and the Institute of Medicine (IOM) has declared that for every dollar spent on ambulatory medications, another dollar is spent to treat new health problems caused by the medication.3 Despite the presence of these avoidable adverse events and costs, it has been determined that potentially up to half of patients on persistent medication receive no drug monitoring in 1 year.4–5 The IOM predicts that with these trends, the number and costs of outpatient ADEs will increase unless effective interventions to improve health-care system delivery and outpatient safety are implemented.

There are multiple factors that contribute to the medication use problems and their negative outcomes. These include patient-centered factors, therapy-related factors, social and economic factors, and disease factors.6 Health literacy, cost, concern about adverse effects, lack of urgency about the disease, and an impaired perception of the efficacy of the medications are just a few specific patient-centered examples. Societal issues like poverty, cultural differences, and a lack of a social support structure create obstacles for treating the population as a whole. Lastly, problems with the health-care system such as lack of accessibility, long waiting times, difficulties filling prescriptions, or unpleasant interactions with health-care professionals also affect patient's medication use experience and may result in medication-related problems.

Pharmacists are in an excellent position to address these problems due to their focused training, unique perspective, and unparalleled access. Pharmacists have the most specific training in drug therapy of all health-care professionals, which creates an opportunity to evaluate a patient's medication needs in a manner that is unique to the health-care team. In the ambulatory care environment, pharmacists are the most accessible health-care professionals. While most health-care professionals require an appointment or emergency situation to be accessible to patients, the ease of access to community pharmacists allows them to often serve as the first and/or the most frequent point of contact between a patient and their health-care team.

However, to take ...